ESPN 53rd Annual Meeting

ESPN 2021


 
Limited value of thrombophilia screening in kidney transplantation – do we need a clinical risk stratification guideline?
CHERYL LIM 1 MANISH SINHA 1 NABIL MELHEM 1

1- EVELINA LONDON CHILDREN’S HOSPITAL
 
Introduction:

Thrombosis is a rare but catastrophic complication in the context of paediatric kidney transplantation. Whilst thrombophilia is often implicated, there are few data to support this association. We describe the prevalence of thromboembolic events (TEs) in paediatric kidney transplant recipients and assess the clinical utility of pre-operative thrombophilia screening.

Material and methods:

Single-centre, retrospective study of all paediatric kidney transplant recipients aged 1-18 over a 5 year period.

Results:

84 children included with a mean age of 11.1 ± 5.2 years. 54(64.3%) boys, 59(70.2%) white-Caucasian, and 48(57.1%) with CAKUT. 61(72.6%) were receiving dialysis at time of transplantation. All participants underwent thrombophilia screening pre-transplantation to identify inherited and acquired abnormalities of coagulation.

 

Abnormal thrombophilia screen was recorded in 37(44.0%) with 20(23.8%) showing persistent abnormalities upon repeat testing. 11(13.1%) had anticardiolipin (AC) antibodies, 11(13.1%) lupus anticoagulant (LA) antibodies , 2(2.4%) elevated homocysteine, and 5(6.0%) were heterozygous for thrombophilic gene mutations. 21(25.0%) started prophylactic unfractionated heparin post-operatively as per haematologist advice pre-transplantation and 10(11.9%) following intraoperative decision by transplanting surgeon.

 

Overall, TEs occurred in 10(11.9%) patients. 6(7.1%) pre-transplant of whom only two had  LA antibodies. A further 4(4.8%) TEs occurred post-transplant of whom one had abnormal screening (AC antibodies and protein S). Graft loss did not occur following TEs. There was no association between pre-operative thrombophilia screening and pre or post-transplant TEs (p=0.70). Dialysis and non-White ethnicity was associated with abnormal thrombophilia screening (p=0.04 and p<0.01 respectively).

Conclusions:

We found a high prevalence of thrombophilia in our pre-transplant population, particularly in those on dialysis and of ethnic minorities. Despite high prevalence of abnormal tests, we observed lack of significant predictive value of detailed testing. Risk stratification could improve our approach to transplant thromboprophylaxis, with focus on patients with previous TEs and on dialysis.